Will New Smokeless Tobacco Products Cut or Boost the Smoking Rate?

With cigarette sales falling, the smoking industry is going smokeless. Companies like R.J. Reynolds and Philip Morris are introducing new smokeless tobacco products that are nothing like your granddaddy’s messy chew or dip.

The companies say these new products - one is called “snus” - help tide smokers over when they go to places where they can’t light up any more because of smoking bans, like restaurants and offices.

Since the bans started going into effect 25 years ago, more and more people have given up cigarettes. Today, the smoking rate is half what it was 40 years ago.

And so the companies are investing heavily in developing smokeless, and in changing its image from hillbilly to hip.
Think smokeless tobacco, and you probably conjure up something distinctly unappealing: a bulging mouthful of wet, brown goo that is smelly and spitty, brown and drooly.

Not anymore: now there’s snus.

“There’s no spitting or anything so no one knows you’re doing it,” Justin Billings, who uses snus, told “60 Minutes” correspondent Lesley Stahl.

When he uses it, Billings tucks it - a tiny tea bag-like pouch filled with tobacco - discretely under his upper lip. There’s no lump in his cheek, and no juice.

He uses snus in class and told Stahl it’s great. “I can be in class and instead of looking like, ‘Oh, there’s 40 minutes left in this class. I just want a cigarette,’ I can put the snus in and continue to pay attention and don’t have to focus on the tobacco craving.”

Snus curbs the craving as the nicotine absorbs into his gums.

Billings is 31, a musician and college student in Los Angeles, who has smoked since he was 16.

“Kind of grassy,” Stahl remarked taking a whiff of snus.

Philip Morris and R.J. Reynolds have been selling their brands of Marlboro and Camel snus for about a year. At $4 a can, about half what a pack of cigarettes usually costs, the companies say sales show snus is catching on.

“I have a cigarette when I get up in the morning,” Billings told Stahl.

He used to dread being stuck someplace where he couldn’t feed his habit. Now he’s buzzed on nicotine practically 24/7. As he heads off to the gym, he pops in a snus.

“I’ll put the snus in. And instead of walking, I can jog to the gym because I’m not carrying a cigarette. You can’t jog carrying a cigarette,” Billings said. “I jog with the snus in.”

And at the gym, he “snusses” while he’s working out. “And I’d feel really good and healthy and in shape,” he told Stahl.

Later at school, he lights up before class and uses snus during class. At night there’s more “snussing” when he’s out with friends at a bar. And unbeknownst to Stahl, he was snussing throughout the interview at a smoke-free restaurant. All in all, he uses about 10 pouches of snus and 20 cigarettes a day.

In the business, Billings they consider him a dual user. “Sometimes I have a snus in and I’ll smoke,” he told Stahl.

Asked why he’d do that, Billings replied by saying, “You seem disappointed in me?”

“I am,” she replied, laughing. “Because I think you’re doubling the harm.”

“But I don’t understand snus to be that bad,” he argued.

Asked if he has a feeling that snus is not harmful, Billings said, “I’ve done as much as read the Wikipedia on snus. What little I know is it’s better for you than smoking by quite a bit.”
Dr. Karl Fagerstrom agrees that snus, which originated in his home country of Sweden, is nowhere near as harmful as cigarettes. He’s a nicotine addiction scientist who was awarded a medal from the World Health Organization for his work on medications to help smokers quit.

Asked if he can put a percentage on how much less harmful snus is than smoking, Dr. Fagerstrom said, “There has been many authorities, the Royal College of Physicians in U.K. for example, and they say it’s somewhere between 99 to 90 percent less harmful than smoking. And I do agree with that. That’s the ballpark.”

Fagerstrom says snus is automatically less harmful because there’s no smoke and no inhaling, the cause of most tobacco-related disease.

“Let’s say I’m a smoker, and I quit, and I go to snus. What have I eliminated in terms of harm for myself?” Stahl asked.

“It doesn’t have any impact on the respiratory airways. It may not cause any cancer at all except for a possibility that it might slightly increase the risk of pancreatic cancer, which is not a very common cancer,” he replied.

“No, but it’s a pretty deadly one,” Stahl pointed out. “Does it create more pancreatic cancer than smoking?”

“No, smoking has a higher risk,” Fagerstrom said. “Even on pancreatic cancer�it is a reduced risk.”

He says snus - which has the same level of nicotine as cigarettes - may raise blood pressure, but doesn’t cause heart disease.

What about mouth, the gums or oral cancer?

“The funny thing is that with the Swedish sort of snus, it hasn’t been found in studies that it does cause oral cancer,” Fagerstrom said.

Unlike American chewing tobacco that does cause cancer of the mouth, Swedish snus is regulated by the government as a food product, so the levels of toxins and carcinogens are kept to a bare minimum.

That’s why doctors in Sweden recommend snus to people who simply can’t stop smoking, even though it’s clearly an addictive substance.

They’re following a controversial medical practice called “harm reduction,” and groups like the Royal College of Physicians are pushing it for smokers, saying that less hazardous products like snus “can save millions of lives.”

“At this point in time, I cannot say these products are safer,” Karla Sneegas said.

In the U.S., health officials like Sneegas don’t like the idea of “harm reduction” - where you use another tobacco product to fight smoking. She runs the anti-tobacco program for the state of Indiana.

“I think that these products are going to end up leading to dual use of cigarettes and smokeless tobacco products and we have no idea whatsoever what is the outcome, what’s the health impact of someone not quitting and using both products,” she told Stahl.

“In other words, you’re saying if they do that, it could end up being more harmful?” Stahl asked.

“It could end up being more harmful. We don’t know,” Sneegas replied.

She’s also skeptical of “harm reduction” because tobacco company executives promote it, like Susan Ivey of R.J. Reynolds, the company that makes Camel snus.

“Because I don’t believe that 45 million Americans will quit smoking immediately - that we should pursue a harm reduction strategy,” Ivey argued.
But the tobacco companies are not allowed to advertise snus as a less harmful product. So, the thrust of their Internet ads is that it’s a way to get around the smoking bans.

“The snus guide to workplace boredom,” one online ad exclaims.

Some Web videos are all about snussing at the office or on subways.

And magazine ads urge smokers to “break free” and “just say no” - not to smoking, but to no-smoking laws - laws that have hurt big tobacco’s bottom line.

“My take-home message from that is that these products have been developed for smokers to have a way to get their nicotine fix until they can get to the place where they can have their next cigarette. That is not going to help people stop smoking,” Karla Sneegas argued.

But they have helped people stop in Sweden, where the smoking rate has dropped to the lowest in Europe. Fagerstrom says snus played a big part, particularly with smokers who’ve failed with things like the nicotine patch or gum.

“And the reason for that, we think, is that snus is cheaper, more available. But it also gives more nicotine, which is what they need,” he said.

Martin Timell tried the patch and gum to stop smoking, but like 90 percent of the smokers who do that each year, he failed.

He told Stahl he’s open about his snus use and that there’s no stigma about it whatsoever.

Timell, one of Sweden’s most popular TV hosts, smoked a pack a day for 15 years until his mother, a lifelong smoker, died of lung cancer.

“You said to yourself, ‘Okay, that’s it.’ And you�tried to stop smoking without snus?” Stahl asked.

“Yes, I tried several times. And I didn’t manage. Maybe I’m a weak person, I don’t know. But with snus, it was very, very easy, he told Stahl.

According to Timell, he started snus and stopped smoking just like that because it satisfies the craving.

But now instead of craving cigarettes, Timell craves snus, so he still finds himself at the tobacco store every day, feeding his habit.

“Of course, it would be much better if I wasn’t addicted to nicotine. But I really am,” he admitted.
“Of course, what Sweden is doing or has done is traded one addiction for another addiction,” Stahl told Fagerstrom.

“That’s true. That is true. And this is why I’m saying this is not harm elimination. They are still addicted. And addiction is regarded as a unnatural state. So addiction is a problem. But it’s less of a problem than lung cancer,” he argued.

He says that since Swedes began switching from cigarettes to snus 30 years ago, there’s been a dramatic drop in lung cancer cases. And now, Sweden is asking the European Union to reverse its ban on snus, a ban imposed in 1992, before the latest studies showing its harm reduction impact.

Back in Indiana, R.J. Reynolds is test-marketing its latest generation of smokeless products, Camel Dissolvables, tobacco in the shape of little brown tablets called “Orbs,” or “Strips,” or “Sticks” that literally melt in your mouth. They pack a punch of nicotine equal to as much as two cigarettes.

Karla Sneegas thinks R.J. Reynolds is making dissolvables specifically for teenagers, a charge the company denies.

“You pulled together a group of high school students to discuss orbs. What did they tell you?” Stahl asked.

“One, it looks like candy. And who’s candy made for? Who’s attracted to candy? We are. Kids,” Sneegas replied.

The students noted that Camel orbs look a lot like the candy Tic-Tacs and even have the same minty taste. And the orbs can be used to circumvent tobacco bans in schools. It’s frustrating, says Sneegas, since smoking bans have been successful in getting people to give up cigarettes.

“More smokers do quit. They cut back drastically,” she said. “And you know cutting back is a great first step. Sometimes they go to the point of saying, ‘Well I can’t smoke at work anymore. It’s time to quit. I want to quit anyway. It’s time to quit.”

Her main worry is that if smokeless catches on, people will end up like Justin Billings, smoking and snussing.

Billings says he may use the dissolvables or snus to try to quit cigarettes - someday. But not now. Now he smokes and snusses - any chance he can.

“I can brush my teeth. I can eat dinner,” he told Stahl. “It kind of doesn’t make sense, but with the tooth brushing�it’s either because I’ve forgotten it’s already in there and I just finished the tooth brushing.”

“You’re really addicted. You really are. You’re an addict,” Stahl pointed out.

“Yeah,” he acknowledged. “A lot of people are.”
By Karen Sughrue, CBS
April 4, 2010

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